| NPI | 1588957336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A122385) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S2646) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2024-09-11 |